Cardiac natriuretic peptides, obesity, and insulin resistance: Evidence from two community-based studies

Abigail May Khan, Susan Cheng, Martin Magnusson, Martin G. Larson, Christopher Newton-Cheh, Elizabeth L. McCabe, Andrea D. Coviello, Jose C. Florez, Caroline S. Fox, Daniel Levy, Sander J. Robins, Pankaj Arora, Shalender Bhasin, Carolyn S.P. Lam, Ramachandran S. Vasan, Olle Melander, Thomas J. Wang

Research output: Contribution to journalArticle

100 Scopus citations

Abstract

Background: The natriuretic peptides play an important role in salt homeostasis and blood pressure regulation. It has been suggested that obesity promotes a relative natriuretic peptide deficiency, but this has been a variable finding in prior studies and the cause is unknown. Aim: The aim of this study was to examine the association between obesity and natriuretic peptide levels and evaluate the role of hyperinsulinemia and testosterone as mediators of this interaction. Methods:We studied 7770 individuals from the Framingham Heart Study (n = 3833, 54% women) and the Malmö Diet and Cancer study (n = 3918, 60% women). We examined the relation of plasma N-terminal pro-B-type natriuretic peptide levels (N-BNP) with obesity, insulin resistance, and various metabolic subtypes. Results: Obesity was associated with 6-20% lower levels of N-BNP (P < 0.001 in Framingham, P = 0.001 in Malmö), whereas insulin resistance was associated with 10-30% lower levels of N-BNP (P < 0.001 in both cohorts). Individuals with obesity who were insulin sensitive had only modest reductions in N-BNP compared with nonobese, insulin-sensitive individuals. On the other hand, individuals who were nonobese but insulin resistant had 26% lower N-BNP in Framingham (P < 0.001) and 10% lower N-BNP in Malmö (P < 0.001), compared with nonobese and insulin-sensitive individuals. Adjustment for serum-free testosterone did not alter these associations. Conclusions: In both nonobese and obese individuals, insulin resistance is associated with lower natriuretic peptide levels. The relative natriuretic peptide deficiency seen in obesity could be partly attributable to insulin resistance, and could be one mechanism by which insulin resistance promotes hypertension.

Original languageEnglish (US)
Pages (from-to)3242-3249
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume96
Issue number10
DOIs
StatePublished - Oct 1 2011
Externally publishedYes

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

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    Khan, A. M., Cheng, S., Magnusson, M., Larson, M. G., Newton-Cheh, C., McCabe, E. L., Coviello, A. D., Florez, J. C., Fox, C. S., Levy, D., Robins, S. J., Arora, P., Bhasin, S., Lam, C. S. P., Vasan, R. S., Melander, O., & Wang, T. J. (2011). Cardiac natriuretic peptides, obesity, and insulin resistance: Evidence from two community-based studies. Journal of Clinical Endocrinology and Metabolism, 96(10), 3242-3249. https://doi.org/10.1210/jc.2011-1182